A Case of Delayed Diagnosis of Pulmonary Paragonimiasis due to Improvement after Anti-tuberculosis Therapy

Abstract

Here, we report a case of pulmonary paragonimiasis that was improved with initial anti-tuberculosis (TB) therapy but confused with reactivated pulmonary TB. A 53-year-old Chinese female presented with a persistent productive cough with foul smelling phlegm and blood streaked sputum. Radiologic findings showed subpleural cavitary consolidation in the right upper lobe (RUL). Bronchoscopic and cytological examination showed no remarkable medical feature. She was diagnosed with smear-negative TB, and her radiologic findings improved after receiving a 6-month anti-TB therapy. The chest CT scans, however, obtained at 4 months after completion of anti-TB therapy showed a newly developed subpleural consolidation in the RUL. She refused pathologic confirmation and was re-treated with anti-TB medication. Nevertheless, her chest CT scans revealed newly developed cavitary nodules at 5 months after re-treatment. She underwent thoracoscopic wedge resection; the pathological examination reported that granuloma caused by Paragonimus westermani. Paragonimiasis should also be considered in patients assessed with smear-negative pulmonary TB.

Paragonimiasis Misdiagnosed as Pulmonary Tuberculosis: A Case Report

“…It can usually be confirmed by identifying Paragonimus eggs in the sputum or BAL in the late phase of infection. Since these clinical manifestations are similar to those of TB or lung malignancy, many paragonimiasis patients are initially treated for other diseases due to misdiagnosis [14]. The unique aspect of our case is that the patient comes from a nonendemic area for paragonimiasis.…”

“…In some cases, they pass into the digestive tract and are eliminated in the stool. In most species, the parasite is oval-shaped at this stage, similar to a coffee bean, 8-15 mm long and 4-5 mm wide [14].…”

Pleuropulmonary Paragonimiasis with Multiple Nodules in the Pleura

“…It has been repeatedly demonstrated that pleural fluid of paragonimiasis is eosinophilic and shows increased levels of total protein, LDH, and ADA and decreased levels of glucose ( 7 , 8 , 13 ), which was consistent with the present findings. It is noteworthy that, for paragonimiasis, both the macroscopic and microscopic features of the pleura as well as the laboratory examinations of pleural effusion resemble those of tuberculosis ( 7 , 14 , 15 ). Among patients with paragonimiasis, the frequency of a misdiagnosis and/or treatment for tuberculosis has been found to be 44.4-59.0% ( 16 - 19 ).…”